1960 - 1989

1960

The U.S. Public Health Service reorganizes

A new Division of Nursing composed of the former Division of Nursing Resources and the Office of Public Health Nursing of the U.S. Public Health Service is formed and charged with increasing the number of better educated nurses in practice and improving the quality of patient care.

The American Nurses Association’s Committee on Current and Long-Term Goals presents a proposal to the Association’s House of Delegates recommending the promotion of the baccalaureate degree as the basic educational foundation for professional nursing practice

Since the beginning of the twentieth century, educating nurses in institutions of higher education rather than hospital-based diploma programs remained a long-term goal for the profession. Numerous reports and studies throughout the century echoed calls for the baccalaureate degree to be the primary educational route to professional nursing practice. The Committee on Current and Long-Term Goals’ recommendation propelled the American Nurses Association to more actively strive to elevate standards of nursing education. As a result, the American Nurses Association established a Committee on Education charged with studying current nursing education and making further recommendations for its improvement, formulating basic principles of nursing education, and studying the effect of federal and state legislation on nursing education.

1962

Public Health Service develops the Nurse Scientist Graduate Training Grants Program

This initiative provided support to university graduate science departments that agreed to open their programs to qualified nurses for interdisciplinary research.

Coronary Critical Care Units expanded the concept of intensive care units. These special units were designed to provide quick emergency action for patients at risk of cardiac arrest and other cardiac emergencies. Nurses specially trained in identifying and treating life-threatening cardiac arrhythmias staffed the units.

1963

U.S. Surgeon General’s Consultant Group on Nursing’s report, Toward Quality in Nursing released

Beginning its work in 1961, the Surgeon General’s Consultant Group on Nursing comprised of leaders in nursing, hospital administration, and medicine as well as members of the public, analyzed problems facing the nursing profession and proposed solutions. The Consultant Group’s report, Toward Quality in Nursing, identified several serious issues concerning the profession, including an inadequate educational system, insufficient numbers of new recruits into the profession, a compensation structure that discouraged people from entering the profession, a lack of research on problems in nursing practice, misutilization of available nursing personal, and a deficiency in the number of supervisory and teaching nurses. The report recommended the Federal government create massive funding programs to both increase the number of nurses and improve the educational requirements for nursing. The report resulted in a significant increase in federal investment in nursing education and research and reflected the Kennedy and Johnson administrations’ support for greater government involvement in health care.

Health Professions Education Assistance Act enacted

Passage of the Health Professions Education Assistance Act represented a major increase in the role of the federal government in assuring an adequate supply of health professionals. Intended to address the shortage of health care providers, particularly in rural and inner-city areas, the act funded advanced clinical education in masters’ programs beyond previously funded programs in public health and psychiatric nursing, thus increasing the number of advanced clinical-practice nurses. The act also included funds for construction of new teaching facilities and rehabilitation of existing facilities.

Barbara Resnick and Charles Lewis develop an expanded role for nurses in the medical clinics at the University of Kansas, Kansas City, Kansas

1964

Nurse Training Act enacted

The 1964 Nurse Training Act, the most comprehensive nursing legislation in American history to date, passed with wide Congressional support. The act allocated a total of $283 million over a five-year period. Five provisions comprised the Act including nursing school construction grants, improvement and expansion of nursing educational programs, reimbursement of a portion of their educational costs to hospital-based diploma nursing programs, continuation of the Professional Nurse Traineeship program, and a generous long-term, low-interest student loan program. The act reflected the federal government’s enlarged financial commitment to nursing education. Funds supplied by the act increased enrollment in schools of nursing and led to improvements in the educational structure of nursing. However, the act’s inclusion of support for all three types of nurse education programs—baccalaureate, associate, and diploma—sustained a confusing array of educational choices for new recruits into the profession. In subsequent years, several amendments to the act continued significant federal financial support for nursing education.

American Nurses Association’s House of Delegates approves a recommendation that the association work towards making the baccalaureate degree the educational foundation for professional nursing

Congress passes The Economic Opportunity Act of 1964 as part of the President Lyndon Johnson’s War on Poverty

The Economic Opportunity Act included funding for neighborhood health clinics, sites in which early nurse practitioners were trained and able to open practices.

Medicare and Medicaid legislation enacted

The Medicare and Medicaid legislation provided government-funded health insurance to the elderly (Medicare) and the poor (Medicaid). Signed into law by President Lyndon Johnson, the Medicare and Medicaid programs dramatically increased access to health care for millions of Americans and resulted in a significant rise in utilization of hospitals and other health care services. This challenged both hospitals and the nursing profession to deliver greater amounts of services to a much larger population base.

The American Nurses Association issues a position paper on educational preparation for practice

The American Nurses Association’s definitive statement on nursing education, Educational Preparation for Nurse Practitioners and Assistants to Nurses: A Position Paper, stipulated two levels of nursing practice, a professional level, minimum preparation of which was at the baccalaureate level, and a technical level, minimum preparation of which was at the associate degree level. The paper also identified a nurse assistant position, education for which was recommended to be a short and intensive course in a vocational education institution. The Position Paper’s purpose was to enunciate and clarify the professional association’s stand on educational preparation for nursing practice, which strongly favored institutions of higher education as the appropriate setting for educating nurses. The Position Paper’s proposed schema for nursing education represented a major break from traditional methods of entry into professional nursing practice, which depended on hospital-based schools of nursing. It created significant dissension among nurses particularly among the approximately 78 percent of practicing nurses who were graduates of diploma programs.

Certificate program for pediatric nurse practitioners opens at the University of Colorado

Loretta Ford, nurse and educator, along with pediatrician Henry Silver began this successful demonstration project to establish the viability of an extended role for nurses in delivering comprehensive primary health care services.

First contingent of combat troops sent to Vietnam

American nurse service in Vietnam began in 1956 when three Army Nurse Corps nurses were placed on temporary duty assignment with the United States Military Assistance Advisory Group. As the involvement of the U.S. military increased, the number of nurses assigned to Vietnam grew. The exact number of military nurses who served during the conflict is unknown, although estimates range from 5,000 to over 10,000 nurses. During the war, nurses delivered care to over 304,000 wounded and sick Americans as well as many of the 58,182 service people who were killed as a result of the conflict.

1966

Allied Health Professions Personnel Training Act of 1966 enacted

This amendment to the Nurse Training Act of 1964 added provisions for scholarships for students in need, funds for recruitment programs, and grants to improve teaching.

1967

The Nursing Educational Opportunities Grants program is launched providing $8.4 million in scholarships to 15,900 students

Image, the official journal of the international nursing honor society, Sigma Theta Tau, begins publication

The Symposium on Theory Development in Nursing sponsored by Case Western Reserve University held

This symposium included seminal papers by philosophers James Dickoff and Patricia James who taught in the Yale masters program in nursing.

National Commission for the Study of Nursing and Nursing Education established

The National Commission for the Study of Nursing and Nursing Education was charged with studying problems in nursing practice and nursing education.

The American Organization of Nurse Executives forms

A corporate subsidiary of the American Hospital Association, the American Organization of Nurse Executives is an organization of nurse executives and managers and provides direct nurse participation in the American Hospital Association.

1968

Health Manpower Act of 1968 extends 1964 Nurse Training Act

Primary Nursing introduced by Marie Manthey at the University of Minnesota

Primary nursing, hailed as a new method of nurse-patient assignment, was based on Manthey’s conceptualization that hospitalized patients required one designated nurse to oversee their nursing care on an individual basis. This principle challenged the depersonalization of care that often occurred when patient care was divided into specific tasks met by an assortment of nursing personnel; a practice dominating in hospitals throughout the 1940s, 1950s, and 1960s. Primary nursing valued the centrality of the nurse to patient care and replicated in many respects the nurse-patient relationship used in private duty nursing.

The American Nurses Association rescinds no-strike policy opening the way for organized nurses to use the labor strike as a tool during labor negotiations

This policy effectively reversed the 1950 decision of the American Nurses Association to voluntarily relinquish the right to strike.

Certification boards provided a formal mechanism to acknowledge excellence in the practice of nursing and lay the groundwork for upgrading standards of competence for all nurses. The certification process recognized those who attained specialized knowledge in their clinical field and thus went beyond professional licensing schemes which set minimal standards for professional practice. The “interim” designation of the initial boards was used until a sufficient number of certified nurses took their place on permanent certification boards.

Congress creates the National Center for Health Services Research and Development

1969

American Association of Colleges of Nurses formed

The American Association of Colleges of Nurses formed as an advocacy, educational, and research organization to establish quality standards for undergraduate and graduate nursing education programs in universities and four-year colleges.

Primex program developed at the University of Washington School Of Nursing

The Primex concept, originally developed by nurse Madeleine Leininger, emphasized the expanded role of nurses in providing primary health care. Primex (which stood for primary care extender) programs focused on primary care and preventive services delivered by nurse practitioners. Several other Primex programs opened throughout the country.

American Nurses Association Statement on Graduate Education for Nurses advocates a focus on clinical practice as opposed to clinical education

1970

National Commission for the Study of Nursing and Nursing Education releases report

The National Commission for the Study of Nursing and Nursing Education convened in 1967 to study problems in nursing practice and education. The commission, which received funding from the American Nurses Foundation, the Avalon Foundation, the Kellogg Foundation, and an anonymous benefactor, issued a report entitled An Abstract for Action often referred to as the Lysaught Report, after the commission’s director, Jerome P. Lysaught. An Abstract for Action reviewed issues and problems facing the nursing profession including the existence of a nursing shortage, confusion over changing nursing roles and functions in the health care system, lack of agreement over the appropriate educational setting in which to educate nurses, and difficulties in retaining nurses in long-term jobs. The Commission identified four priorities around which to develop a scheme for change in nursing. These were to increase research into the practice of and education of nurses, improve the nursing educational system, clarify the role of nurses in contrast to those of other health professions for the delivery of optimum care, and increase financial support for nursing to ensure adequate career opportunities to attract and retain the number of nurses required for quality health care.

The American Nurses Association adopts a resolution in favor of a national health insurance program

The American Medical Association adopts Medicine and Nursing in the 1970’s: A Position Statement

Medicine and Nursing in the 1970’s: A Position Statement addressed six areas including the supply of nurses, expanded roles for nurses, nursing education, hospital nursing service, the health care team, and nurse-physician collaboration. The statement re-enforced the concept of the physician as head of the health care team but significantly recognized the need for nurses to assume expanded roles and functions in the delivery of patient care and recommended that doctors seek constructive collaboration with the nursing community. The American Medical Association affirmed its support of hospital based nurse educational programs, identifying such programs as the main source of new nurses.

The Federal government funds a series of projects, including the Primex program and other United States Public Health Service programs to prepare nurses for primary care practice

1971

Secretary of Health, Education and Welfare’s Committee to Study Extended Roles for Nurses releases the report Extending the Scope of Nursing Practice

Extending the Scope of Nursing Practice examined the potential for expanding the use of nurses in the delivery of health care. The Secretary’s committee, which considered the issue of health care delivery from a consumer’s vantage point, recognized the potential for nurses to assume a substantially larger place in the community of professionals delivering health care services. It also noted, however, that many nurses lacked the educational background to assume extended practice roles or did not want to assume them. The report concluded that widening the range of nursing functions was essential if the United States was to provide equal access to health care for all citizens. It also called for nurses to expand their practices to include some responsibilities traditionally performed only by physicians. Barriers to effective utilization of advanced practice nurses were pinpointed and more collaboration between physicians and nurses recommended. The report also noted that state licensure laws presented no obstacles to expanding nursing roles. The report provided incentive for passage of the Nurse Training Act of 1971.

Nurse Training Act of 1971 passed

The 1971 Act expanded and extended federal aid to nursing education and included monies to promote expanded roles for nurses such as the support of nurse practitioner programs, capitation funds to allow for larger student bodies, and support of programs designed to increase both racial and gender diversity in the profession.

National Black Nurses Association forms

Frustrated by the limited opportunities for African American nurses for involvement and full participation in the activities of the American Nurses Association, several black nursing leaders organized a new professional organization, the National Black Nurses Association, to better meet the needs of African American nurses.

U. S. Navy Nurse Corp nurse practitioner program begins

American Assembly on Men in Nursing forms

Idaho passes the first state practice act to recognize diagnosis and treatment as part of the scope of practice of advanced practice and specialty nurses

The National League for Nursing, the American Nurses Association, and the American Medical Association endorse the National Commission for the Study of Nursing and Nursing Education

The endorsement by the National League for Nursing came with a pledge of financial support and services from League offices useful for implementing the commission’s recommendations.

1972

The Laverne-Pisani Act is passed in New York State

The Laverne-Pisani Act was the first state nurse practice act to expand the definition of nursing practice and provide the statutory authority for independent practice for all professional nurses.

National Joint Practice Commission holds first meeting

The National Commission for the Study of Nursing and Nursing Education recommended in its 1970 report, An Abstract for Action, the establishment of a national joint practice organization composed of nurses and physicians to discuss and make recommendations concerning congruent roles and functions of both professions. The Joint Practice Commission, which was composed of an equal number of members from the American Nurses Association and the American Medical Association, received funding from the American Medical Association, the American Nursing Association and the W. K. Kellogg Foundation. The commission, addressed a wide-ranging series of issues including access to care, health care delivery systems, changes in education required to expand the role of nurses, authority and responsibilities of the professions, relationships between the professions, and state regulatory acts. The commission issued a number of pamphlets on state practice acts, certification of nurses and physicians, nursing staff in hospitals, and joint collaborative practice in hospitals and primary care clinics. The Kellogg Foundation ceased commission funding in 1980. In 1980, the American Medical Association voted to terminate its financial support, at which point the commission ended its activities.

Federation of Specialty Nursing Organizations and the American Nurses Association forms

The Federation of Specialty Nursing Organizations and the American Nurses Association formed after an initial 1972 meeting with the American Nurses Association and ten nursing clinical specialty organizations convened to discuss common interests. In 1981, the organization changed its name to the National Federation for Specialty Nursing Organizations.

National Commission for the Study of Nursing and Nursing Education releases its final report

This report, entitled From Abstract Into Action, described the commission’s efforts to put into effect the recommendations of its earlier report An Abstract for Action. The report discussed actions taken, resulting outcomes, and remaining activities requiring attention. During the three-year implementation phase, which commenced with the publication of An Abstract for Action, the commission focused its work in three main areas: the development and expansion of nursing practice together with a reexamination of role relationships among health professions; readjustment of educational systems in nursing to meet current exigencies and provide a foundation for innovation; and emergence of an unambiguous profession that would be a full partner in shaping health policy and serve the needs of the American people.

Board of Directors of the American Nurses Association accepts Interim report of the Task Force on Affirmative Action

The Task Force on Affirmative Action convened in 1972 to develop and implement a program to rectify inequities experienced by minority nurses. The 1973 report included a list of six objectives designed to increase the American Nurses Association’s attention to minority nurses concerns as well as improve the Association’s communication, programs, and activities to maximize involvement of black and other minority nurses in the association.

National Association of Hispanic Nurses forms.

First National Conference on Classification on Nursing Diagnosis held

The First National Conference on Classification on Nursing Diagnosis was called to develop a classification system of nursing diagnoses that would describe the scope of nursing and define its body of knowledge. Nursing diagnoses identify the domain of nursing practice for which the nurse is held accountable. The 1973 Conference aimed to begin an initial effort to categorize nursing knowledge, develop a taxonomic system of diagnoses and establish a codification method appropriate for computerization. Conferences continued to be held yearly subsequent to the 1973 conference. In 1983, the North American Nursing Diagnosis Association (NANDA) was formed and renamed in 2002, the North American Nursing Diagnosis Association International (NANDA-I).

1974

Taft-Hartley Act amended to cover nonprofit hospitals

Amendments to the 1947 Taft-Hartley Act ended the exemption of nonprofit hospitals from coverage by the National Labor Relations Act. This extended collective bargaining rights to nurses employed in nonprofit hospitals and other health care facilities.

Nurse Training Act of 1975 passed

The 1975 Nurse Training Act was the first major revision of the Nurse Training Act since its original passage in 1964. The 1975 act added funds for nurse practitioner programs and mandated a study of the supply and distribution of nurses for use as a guide for future legislation. It reflected a shift in emphasis from legislation designed to address nurse shortages to legislation dealing with maldistribution of nurses.

First convention of American Indian Nurses Association held

This association formed to address issues relevant to the health of Native Americans as well as professional concerns of Native American nurses. The association was succeeded by the American Indian Alaska Native American Nurses Association and later by the National Alaska Native American Indian Nurses Association. The National Alaska Native American Indian Nurses Association is a member of the National Coalition of Ethnic Minority Nurses Associations.

The Health Planning and Resource Development Act signed into law by President Gerald Ford

This act, creating a nationwide system of health planning and resource development, represented a new approach to national, state, and local comprehensive health planning. The major aim of the act was to promote quality of care while slowing down rising health care costs. The act identified a set of ten national health care priorities one of which was increased training and utilization of health care providers such as nurse clinicians. The act failed to effectively constrain health care costs.

1976

The Professions Education Act amended the Nurse Training Act to give special financial assistance to applicants who practice in areas with a serious shortage of nurses

1977

Denver nurses file class action suit in U.S. District Court alleging widespread sex discrimination and undervaluation of nurses’ services by the city and county of Denver

Lemons v. the City and County of Denver went beyond the traditional doctrine of equal pay for equal work and raised the issue of comparable worth. Those involved in the suit alleged that certain jobs possess enough similarities to other jobs based on educational preparation, responsibility, and skill level that comparable wages should be paid for both. The nurses presented evidence that city and county starting salaries for such workers as sign painters, tree trimmers, and tire service men (traditionally male occupations) were higher than those for nurses (a traditionally female occupation). The nurses failed to convince two judges in the case who ruled against them. The nurses appealed the case to the Supreme Court which declined to hear the case.

1978

President Jimmy Carter pocket vetoes Nurse Training Act amendments

In vetoing the amendments, President Carter stated that they authorized expenditures in excess of the needs of nurse training programs and cited the need to curb inflation. Nursing groups quickly refuted the contention that the supply of nurses was adequate, noting reports of nurse shortages throughout the country.

1979

President Jimmy Carter signs Nurse Training Act amendments

Signing this act reversed an earlier stand taken by President Carter when he vetoed the 1978 Nurse Training Act amendments. However, the new amendments allocated only half the monies originally proposed. The measure provided funds for special projects, student loans, traineeships for nurse practitioners and nurse anesthetists, and construction grants to schools of nursing. The revised act also directed the National Academy of Sciences to study and report on future nursing manpower needs and make recommendations about future federal support of nursing education.

1980

American Nurses Association releases Nursing: A Social Policy Statement

Nursing: A Social Policy Statement was a wide ranging position paper which defined and identified the distinguishing characteristics of nursing practice and described the profession’s responsibilities to the public.

1981

Department of Health and Human Services publishes The Recurrent Shortage of Registered Nurses: A New Look at the Issues

This report identified low salary levels as the causative factor of nurse shortages. The report noted that the numbers of entrants into nursing programs are positively related to beginning salaries for nurses. High salaries initially attract new recruits into the profession. But as the number of nurses increases salaries first level off and then decline relative to other fields. The lower resulting salaries make nursing less attractive to new entrants and lead to a decrease in the number of nurses. Once the number of nurses decreases a new cycle of nurse shortages occurs. The report casts doubts regarding the effectiveness of federal funding for nursing education in relieving nurse shortages placing instead primacy on market forces.

This committee advised the Secretary of Health and Human Services that an oversupply of physicians would be evident by 2000. The report also cautioned against increasing the number of nurse practitioners, certified nurse midwives, and physician assistants until the need for them could be determined.

1982

American Academy of Nursing identifies forty-one hospitals as “Magnet Hospitals”

The Magnet Hospital program identified hospitals that were satisfying places for nurses to work and were considered models of nursing practice. Magnet Hospitals provided a workplace environment for nurses that allow them to practice under optimum conditions. The Magnet Hospital program developed into a form of accrediting for hospital nursing services and presently is administered through the American Nurses Credentialing Service, a subsidiary of the American Nurses Association.

1983

The Institute of Medicine releases its study entitled, Nursing and Nursing Education: Public Policies and Private Action

The Institute of Medicine Committee was charged with investigating whether there was a need for continued federal support of nursing, ways to get nurses in underserved areas, and how to encourage nurses to remain active in their profession. The committee carried out a sophisticated and well-documented analysis of problems in nursing, yet erroneously concluded that the supply and demand of generalist nurses was in balance. The committee did identify several problems in nursing including nurses’ dissatisfaction with their scope of practice and role definition and the job strain and mental and physical fatigue they experienced. The committee did not recommend a single educational standard for entry into nursing practice but called for continued easy access to nursing jobs and more funds for preparing nurse practitioners.

The Tax Equity and Fiscal Responsibility Act reduced many federal health programs and mandated the development of a Prospective Payment System for calculating Medicare reimbursement to hospitals. Medicare’s original hospital reimbursement system used a retrospective system in which hospitals received reimbursement for their services based on whatever services the patient received. The Prospective Payment System reimbursed hospitals with a flat payment based on the patient’s diagnosis. Rates paid to hospitals were set in advance, calculated from a listing of diagnoses called Diagnostic Related Groups. Hospitals that treated the patient for less than the reimbursement provided were able to keep the difference. Hospitals that treated the patient for more lost money. The intent of the program was to lower rising hospital costs and institute efficiencies in hospital operations. Hospitals quickly adjusted to the new reimbursement scheme by discharging patients faster. In the aftermath of the Prospective Payment System, the acuity rate of hospitalized patients increased dramatically and profoundly affected nursing practice. The increased nursing needs of hospital patients created greater demands on nurses and led to nurse shortages.

1985

Institute of Medicine releases report Preventing Low Birthweight

The Committee to Study Prevention of Low Birthweight examined causes of low birthweight and intrauterine growth retardation and identified measures effective in dealing with these problems. The committee concluded that prevention would contribute significantly to a reduction in low birthweight and an improvement in child health. The committee recommended increasing reliance on certified nurse midwives and nurse practitioners as one means of improving access to care for at-risk pregnant women. The committee also noted that state laws should be supportive of collaboration between certified nurse midwives and nurse practitioners.

1986

The National Center for Nursing Research at the National Institutes of Health is established

The establishment of a National Center for Nursing Research represented a major step for the profession by advancing scientific research on nursing and providing critical federal financial support. The center, which was originally vetoed by President Ronald Reagan, received wide support from both Republicans and Democrats. It became the National Institute of Nursing Research in 1993. The National Institute of Nursing Research supports and conducts clinical and basic research and research training on issues of health and illness across the lifespan.

The report, which was based on extensive analysis of a large number of studies, concluded that the quality of care provided by nurse practitioners, physician assistants, and nurse midwives was equivalent to care provided by physicians. It noted high satisfaction among patients cared for by these professionals and found that they were cost-effective providers of quality health care.

North Dakota becomes first state to require a Bachelors of Science in Nursing degree for registered nurse licensure and an Associate Degree in Nursing for licensed practical nurse licensure

1988

Secretary’s Commission on Nursing releases its final report

The Secretary’s Commission on Nursing was appointed to determine if there was a shortage of hospital nurses and concluded that a widespread and significant shortage did exist. The commission found that the shortage was related to constantly rising hospital demand for nurses. Hospitals contributed to nurse shortages by paying nurses low wages thus making nurses a relative low cost all-purpose employee group which could be used by hospitals to perform non-nursing jobs. The commission predicted continued high demand for nurses, recommending higher nurse salaries, better staffing patterns, increased use of assistants and technology, involvement of nurses in decision-making and federal support of entry-level nursing education.